4.1 CEO briefing to the Board
The Board held a detailed discussion with the CEO and A/CFO regarding the YTD financial position. Significant concern was expressed regarding the current level of expenditure in excess of budget and the projected year-end overspend. The Board noted that at end March 2026, the HSE is over budget by €150.7m / 3.2%, (deficit of €145.8m Department of Health (DoH) and €5.0m Department of Children, Disability and Equality (DCDE)).
The CEO advised that, following consideration of the Quarter 1 2026 financial position under the Performance and Accountability Framework (PAF) 2026, three Regional Areas were placed into Tier 3 escalation and the remaining three into Tier 1 escalation with effect from 29 April 2026. The CEO outlined to the Board the escalation requirements and the associated processes in cases where required improvements are not achieved.
The Board discussed governance arrangements, performance oversight, and regional capability. Board members noted the need for greater clarity and consistency in governance structures, alongside stronger central oversight and coordination. It was recognised that the current model has reduced visibility and oversight at the centre, with some regional functions operating with significant autonomy, making it more challenging to maintain a consistent view of performance across the system. The CEO acknowledged these challenges.
Discussion also focused on whether additional senior-level support may be required to strengthen oversight, coordination, and decision-making. Existing reporting arrangements were considered insufficient in providing a clear picture of operational performance and emerging risks, highlighting the need for more robust and actionable information.
Regional performance was described as variable, while regions are broadly operating as intended, concerns were raised about capacity in some areas to manage ongoing financial and operational pressures effectively. Particular challenges were noted in relation to pay and non-pay management, disabilities, mental health, and income generation. It was acknowledged that these pressures are being experienced across the wider system.
The Board considered the significant financial challenges facing the organisation and emphasised the importance of maintaining strong financial discipline while continuing to deliver services in a high-demand environment. Different views were expressed on the balance between regional autonomy and increased central oversight, with agreement that any changes to authority arrangements would require careful consideration.
Board members also highlighted the importance of strengthening performance monitoring through clearer metrics and earlier identification of emerging risks to support timely intervention where needed. There was broad recognition of the sustained pressures facing the system and the seriousness of the current position.
The potential value of targeted reviews and benchmarking exercises was also discussed, including opportunities to learn from previous reviews and assess the effectiveness of specific services and delivery models to support continuous improvement and accountability.
It was agreed that further work would be undertaken to review governance and oversight arrangements, enhance the quality and timeliness of performance reporting, clarify finance roles and responsibilities, and assess regional support requirements. The CEO agreed to revert to the Board in a timely manner with proposals to address the matters raised.
4.2 CEO Monthly Report
Members of the Senior Leadership Team joined the meeting.
The CEO reported to the Board on a number of the key significant areas as set out in the CEO Monthly Report.
The CEO reported to the Board on her first month which focused on establishing key relationships, gaining clarity on the organisation’s principal risks and priorities, and setting clear expectations around performance, financial control, and accountability. The CEO advised the Board that meetings took place with senior leadership, Board members, and Regional Executive Officers and teams, with a particular focus on UEC, financial performance and agency controls. Engagements also took place with the Minister for Health, the newly appointed Secretary General of the DoH, An Taoiseach, Minister for Children, Disability & Equality and other key partner agencies.
The CEO provided an update to Board members in relation to the significant national disruption caused by the fuel protests in early April, noting that the National Crisis Management Team was convened to coordinate the health response, with daily meetings held during the peak of the response and liaising with Departments and Ministers extensively. The CEO and Board acknowledged with thanks the work of all staff, both from a coordination and care delivery perspective, for managing a very challenging situation with minimal impact on patients.
The CEO reported to the Board on Urgent and Emergency Care, outlining significant increased attendances after the Easter holiday period which resulted in higher trolley numbers in some sites. She outlined that analysis has shown that, in part, pressure was driven by an increase in urgent elective activity, notably in haematology and oncology, with OPD admissions increasing 36.4% compared to the previous week.
The Board noted the campaign to appoint a National Director for Disabilities was not successful, and the CEO advised the Board that she is liaising with the A/CPO and Secretary General of DCDE in relation to next steps in relation to the Disabilities Function.
The CEO outlined to the Board the implementation of the revised senior management arrangements with the establishment of the Senior Management Team (SMT) which will focus on decision-making, operational oversight, and performance delivery; and a refocused Senior Leadership Team (SLT) with strengthened responsibility for strategy, assurance, and forward planning; and the Board noted the establishment of a Performance Advisory Group to enhance performance oversight across regions and national services.
The CEO reported to the Board on workforce numbers, noting the WTE increase of 622 between February and March, leaving headroom of 1,270 WTE within the year-to-date ceiling. A material proportion of recruitment relates to Health and Social Care Professions. Active management of the pay bill remains critical to ensure agency overspend does not constrain permanent recruitment.
The Board noted the update in relation to the One Health Record programme with the evaluation of responses to the Requests to Participate underway, and shortlisting for Competitive Dialogue expected in the coming weeks, representing a major programme milestone, and noted further Digital for Care developments outlined in papers presented.
National Performance Report
The monthly National Performance Report (NPR) February 2026 data was presented to the Board.
The Performance Committee also reviewed this at its meeting on 23 April 2026. The Board approved the February 2026 NPR for submission to the Minister for Health, and Department of Children, Disability and Equality (DCDE), and noted that once submitted, the NPR will be published on hse.ie.